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Study: More Than Half of Stroke Patients Fail to Meet Cholesterol Targets

Author sees opportunity to improve stroke prevention

A new U.S./Canadian study has shown that more than half of patients with recurrent stroke or other cerebrovascular attack failed to meet recommended target levels for low-density lipoprotein cholesterol (LDL-C) –– the so-called “bad” cholesterol.

The observational study, led by researchers at the University of Toronto, used data from the Get-With-The-Guidelines Stroke Registry, which included patients who experienced an acute ischemic stroke or transient ischemic attack (TIA) during the period from April 2003 to September 2012. The participants were classified as high risk if they had a history of TIA, stroke (cardiovascular disease), or coronary artery disease (CAD).

Of 913,436 patients admitted with an acute stroke or TIA, 194,557 (21.3%) had experienced a previous stroke or TIA; 148,833 (16.3%) had previous CAD; and 88,605 (9.7%) had concomitant CAD and cardiovascular disease.

Overall, only 68% of patients with stroke were at their preadmission National Cholesterol Education Program III guideline-recommended LDL-C target; 51.3% had LDL-C levels of less than 100 mg/dL, and only 19.8% had LDL-C levels of less than 70 mg/dL. Among those presenting with recurrent stroke, more than 45% had LDL-C levels of greater than 100 mg/dL.

When compared with patients with CAD, patients with previous TIA or stroke were less likely to have LDL-C levels of less than 100 mg/dL or less than 70 mg/dL.

The authors noted that older age, male sex, Caucasian race, lack of major vascular risk factors, previous use of cholesterol-lowering therapy, and care provided in larger hospitals were associated with meeting LDL-C targets on admission testing.

“I think our study reveals that there is a good opportunity for improving stroke and cardiovascular prevention,” said lead author Gustavo Saposnik, MD, MSc, FRCPC.

Saposnik suggested that four factors could be at play in the study’s results: 1) doctors might not have prescribed the recommended lipid-lowering medications; 2) patients might not have taken the medication; 3) patients may not have been able to afford the medication; or 4) patients who were taking the medication might have had such high LDL-C concentrations that these levels remained above the recommended target.

According to Dr. David Frid of the Cleveland Clinic, part of the problem might also be the fact that neurologists, who take care of stroke patients, might not be as eager to prescribe cholesterol-lowering drugs as cardiologists.

Sources: Reuters; October 27, 2014; and Stroke; October 9, 2014.

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